| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
19,614 |
14,644 |
$4.40M |
| D1120 |
Prophylaxis - child |
4,974 |
3,938 |
$109K |
| D1206 |
Topical application of fluoride varnish |
7,398 |
5,915 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,450 |
3,576 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
616 |
294 |
$59K |
| D0330 |
Panoramic radiographic image |
1,093 |
859 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,655 |
1,309 |
$46K |
| D1110 |
Prophylaxis - adult |
1,822 |
1,395 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
148 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,188 |
1,724 |
$33K |
| D1351 |
Sealant - per tooth |
552 |
137 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,260 |
1,089 |
$13K |
| D0274 |
Bitewings - four radiographic images |
823 |
677 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
794 |
593 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
128 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
112 |
$7K |
| D0180 |
|
139 |
111 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
378 |
268 |
$3K |
| D9310 |
|
32 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$216.00 |
| D4342 |
|
30 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D0190 |
|
341 |
341 |
$0.00 |
| D4910 |
|
13 |
13 |
$0.00 |